Provider Demographics
NPI:1366426132
Name:MCCLUNG, LAWRANCE H (LICSW)
Entity type:Individual
Prefix:MR
First Name:LAWRANCE
Middle Name:H
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:LAWRANCE
Other - Middle Name:H
Other - Last Name:MCCLUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1601 E FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3713
Mailing Address - Country:US
Mailing Address - Phone:360-558-5728
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-558-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611734331041C0700X
UT5199106-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107035228101OtherU006
UT51991063500001OtherBLUE CROSS
UT885125OtherU002
UT942938348MCMOtherU003
UT942938348MCMOtherU003
UT003104023Medicare ID - Type Unspecified
UT107035228101OtherU006